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A Randomized Controlled Trial of Adaptive Ventilation for Cheyne–Stokes Breathing in Heart Failure

Oxford Sleep Unit and Respiratory Trials Unit, Oxford Centre for Respiratory Medicine, Churchill Hospital Site, Oxford Radcliffe Hospital, Oxford, United Kingdom

Correspondence and requests for reprints should be addressed to Justin C. T. Pepperell, M.R.C.P., D.A., Taunton and Somerset NHS Trust, Musgrove Park Hospital, Taunton, Somerset, TA1 5DA, U.K. E-mail: justinpepperell{at}doctors.org.uk

Heart failure is associated with Cheyne–Stokes breathing, which fragments patients' sleep. Correction of respiratory disturbance may reduce sleep fragmentation and excessive daytime sleepiness. This randomized prospective parallel trial assesses whether nocturnal-assist servoventilation improves daytime sleepiness compared with the control. A total of 30 subjects (29 male) with Cheyne–Stokes breathing (mean apnea–hypopnea index 19.8 [SD 2.6] and stable symptomatic chronic heart failure (New York Heart Association Class II–IV) were treated with 1 month's therapeutic (n = 15) or subtherapeutic adaptive servoventilation. Daytime sleepiness (Osler test) was measured before and after the trial with change in measured sleepiness the primary endpoint. Secondary endpoints included brain natriuretic peptide levels and catecholamine excretion. Active treatment reduced excessive daytime sleepiness; the mean Osler change was +7.9 minutes (SEM 2.9), when compared with the control, the change was -1.0 minutes (SEM, 1.7), and the difference was 8.9 minutes (95% confidence interval, 1.9–15.9 minutes; p = 0.014, unpaired t test). Significant falls occurred in plasma brain natriuretic peptide and urinary metadrenaline excretion. We conclude that adaptive servoventilation produces an improvement in excessive daytime sleepiness in patients with Cheyne–Stokes breathing and chronic heart failure. This study suggests improvements in neurohormonal activation with this treatment.

Key Words: sleep apnea • brain natriuretic peptide • placebo • positive airway pressure • randomized controlled trial

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